Please complete the credit application form below. In addition to this application, you must send us your most recent two years of audited financial statements (Balance Sheet, Income Statement and Cash Flow Statement) and current interim statements. If it is unaudited, the respective owner/officer must sign and date each financial statement indicating the period covered by each statement.

You can send us this information via e-mail (CreditCommittee@spectralogic.com) or via fax (1-303-939-8844).

Please email us at CreditCommittee@spectralogic.com if you have any questions or require assistance.

 
Company Information
 
 
 
 
 
Company Name
 
 
 
 
Doing Business As:
 
 
 
 
Company Website Address:
 
 
 
 
Company Form
 
 
 
 
Business Type
 
 
 
 
Primary Customer Focus (if reseller)
 
 
 
 
Year Business Started
 
 
 
 
Number of Employees
 
 
 
 
Last Month of Fiscal Year
 
 
 
 
Annual Revenue for Most Recent Fiscal Year:
 
 
 
 
Profitable for Two Most Recent Fiscal Years:
 
 
 
 
Do You Have Audited Financial Statements:
 
 
 
 
Duns and Bradstreet Number:
 
 
 
 
Primary Company Phone:
 
 
 
 
Physical Address:
 
 
 
 
City/Town:
 
 
 
 
State
 
 
 
 
Zip/Postal Code:
 
 
 
 
Non-U.S. Providence/State:
 
 
 
 
Country
 
 
 
 
Tax Exempt?
 
 
 
 
Tax ID Number:
 
 
 
 
Parent Company Name (if subsidiary):
 
 
 
 
Parent Company Phone (if subsidiary)
 
 
 
 
 
 
 
 
 
Contact Information
 
 
 
 
 
Owner/CEO Name
 
 
 
 
Owner/CEO Phone
 
 
 
 
Owner/CEO E-mail
 
 
 
 
 
 
 
Accounts Payable Contact Name
 
 
 
 
Accounts Payable Contact Phone
 
 
 
 
Accounts Payable E-mail
 
 
 
 
 
 
 
Finance Contact Name
 
 
 
 
Finance Contact Phone
 
 
 
 
Finance Contact E-mail
 
 
 
 
 
 
 
Banking Information
 
 
 
 
 
Bank Name
 
 
 
 
Bank Account Type
 
 
 
 
Bank Account Number
 
 
 
 
Bank Line of Credit
 
 
 
 
 
If Yes, Credit Limit:
 
 
 
 
If Yes, Line of Credit Account Number
 
 
 
Bank Contact Name:
 
 
 
 
Bank Contact Phone:
 
 
 
 
Bank Contact E-mail:
 
 
 
 
 
 
 
 
 
Supplier Credit Information
 
 
 
 
 
Supplier 1 Contact Name
 
 
 
 
Supplier 1 Accounts Receivable Contact Name
 
 
 
 
Supplier 1 Accounts Receivable Contact Phone Number
 
 
 
 
Supplier 1 Accounts Receivable Contact E-mail
 
 
 
 
 
 
 
Supplier 2 Contact Name
 
 
 
 
Supplier 2 Accounts Receivable Contact Name
 
 
 
 
Supplier 2 Accounts Receivable Contact Phone Number:
 
 
 
 
Supplier 2 Accounts Receivable Contact E-mail
 
 
 
 
 
 
 
Supplier 3 Contact Name
 
 
 
 
Supplier 3 Accounts Receivable Contact Name:
 
 
 
 
Supplier 3 Accounts Receivable Contact Phone Number:
 
 
 
 
Supplier 3 Accounts Receivable Contact E-mail
 
 
 
 
 
 
 
Order Information
 
 
 
 
 
Currency of First Order:
 
 
 
 
Estimated Amount of First Order (in U.S. Dollars):
 
 
 
 
Notes/Comments Regarding your Credit Application:
 
 
 
 
 
 
 
 
 
Attachments
 
 
 
 
 
File Upload
 
 
 
 
File Upload
 
 
 
 
File Upload
 
 
 
 
 
 
 
 
 
Signature
 
 
 
 
 
Name
 
 
 
 
Title
 
 
 
 
Signature
 
 
Date